Medi-Cal transfer next year for youths

Coverage for children in low income families part of care overhaul

yamaro@mercedsunstar.comOctober 30, 2012 

About 8,000 children in Merced County will be transferred to Medi-Cal from Healthy Families, the state's low-cost insurance program, next year.

Some 875,000 children will make the shift statewide.

Healthy Families will be eliminated after the transition is complete -- a move that's expected to save the state approximately $72 million annually, according to the state Department of Health Care Services.

Medi-Cal is the state's Medicaid program and provides health coverage for low-income families.

The Central California Alliance for Health, which manages Medi-Cal care in Merced County, will serve children in Merced when the transfer happens, said Alan McKay, the group's executive director .

"We believe that we have the capacity for those kids to have their medical home within the alliance health plan," he said. "We are confident that we will be able to make that transfer successfully."

Children up to the age of 19 will be transferred in four different phases, said Norman Williams, the Department of Health Care Services' deputy director for public affairs.

Those in the first phase will make the move on Jan. 1 -- primarily children who are already in a plan that's active in Medi-Cal. The second phase will be in April, followed by the third phase in August and fourth phase in September.

Children in Merced County will be a part of the third phase, McKay said. Their families will have to select a new managed care plan, Williams said.

The overall transition will create one comprehensive health program and will simplify the eligibility process for all children in the state who are at or below the federal poverty guidelines for the program, Williams said. There are certain benefits that children will receive under Medi-Cal that weren't offered under Healthy Families.

For example, children will receive the preventive care benefits from the Early and Periodic Screening, Diagnosis and Treatment benefits under Medi-Cal, Williams said.

It will allow the state to make the plans accountable for high-quality services on a constant basis, he said. "It lets us coordinate care in a way that hasn't been done before," he said.

The change is expected to result in savings to the state and the participants, Williams said. "For more of the transfers, they won't pay a premium any more," he said.

Those who do have to pay a premium will pay less than they did under Healthy Families, Williams said.

Under Medi-Cal, the premiums will be $13 for each child or $39 for a family with four children or more. Under Healthy Families, the premiums ranged from $4 to $24 for each child, he said, or around $72 for a family of four or more.

Some concerns raised

Some have concerns that the shift might create a disruption in care for children and a lack of access to specialists and doctors they need.

Anthony Wright, executive director for Health Access California, a statewide health care consumer coalition, said his group was not in favor of eliminating Healthy Families but realizes the plan is moving forward.

"We think it's aggressive and that it may be too quick to ensure that there won't be disruptions in care," he said.

The coalition wants to make sure that the care plans are ready to take the children, and that they don't face a lack of access to doctors since providers are reimbursed less under Medi-Cal, he said.

"We want to make sure that at the end of the day they get the care that they need," he said.

Williams believes that more than 83 percent of the managed-care plans contract with Healthy Families and Medi-Cal. "We are working with those who don't to help ensure that their children keep their same providers, same doctors," he said.

Tony Cava, spokesman for the state Department of Health Care Services, said the agency will be mailing out letters to parents of children who will be transferred as part of the first phase. The 60-day notice will go out Thursday, and a second reminder will go out Dec. 1.

Ninety-, 60- and 30-day notices will go out to parents with children being transferred as part of the other phases, Cava said. The letters include a description of the transition, an overview of the options they have and whom to contact if they have any questions.

Reporter Yesenia Amaro can be reached at (209) 385-2482 or yamaro@mercedsunstar.com.

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